Butwick et al identified risk factors associated with postpartum anemia. Early detection of anemia allows for interventions that can reduce the severity of anemia and avoid the need for blood transfusions. The authors are from Stanford University and Kaiser Permanente North California.

Patient selection: woman post-partum after Cesarean section


Outcome: severe post-partum anemia, with hemoglobin < 8 g/dL


Risk factors for post-partum anemia:

(1) anemia prior to delivery, based on prepartum hemoglobin in g/dL

(2) post-partum (peripartum) hemorrhage, with estimated blood loss >= 1,000 mL


Prepartum Hemoglobin

OR Severe Anemia

>= 11 g/dL


10 to 10.9 g/dL


< 10 g/dL



Some possible explanations for pre-partum anemia:

(1) untreated or undertreated iron deficiency anemia

(2) no or limited prenatal care

(3) hemorrhage since last exam

(4) failure to test and treat

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